IJGII Inernational Journal of Gastrointestinal Intervention

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< PreviousNext >Gastrointestinal Intervention 2016; 5(1): 1~83
  • Review Article 2016-03-31

    Endoscopic resection for early gastric cancer: The current controversies

    Xian Feng Xia, and Philip Wai Yan Chiu

    Abstract : Gastric cancer remained second commonest cancer worldwide. The diagnosis of early gastric cancer (EGC) is increasing in Japan and South Korea resulting in better oncological outcomes. Endoscopic resection (ER) is safe and effective treatment for EGC with minimal risk of lymph node metastasis. The oncological clearance of ER for EGC in expanded criteria remains controversial. Several retrospective studies showed that endoscopic submucosal dissection (ESD) achieved minimal local recurrence and excellent survival for EGC in expanded indications. With an increasing trend of cancer occuring in the aging population, ER will play a major role in treatment of EGC among elderly who usually have multiple comorbidities. Salvage gastrectomy is generally recommended for those with non-curative ESD, while further researches should be conducted to refine the risks of nodal metastasis for various submucosal EGCs. Endoscopic surveillance is recommended for long term follow-up of patients after curative ESD as the risk of metachronous cancer is significant. Eradication of Helicobacter pylori is generally recommended for EGC treated by ER with a view to reduce the risk of metachronous tumor.

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  • Review Article 2016-03-31

    Endoscopic management of postsurgical leaks

    Hany Shehab

    Abstract : Postsurgical leaks are a major complication with significant mobidity and mortality. Conventional conservative and surgical approaches are highly morbid with limited success. Over the last decade several endoscopic techniques have proved effective with a favorable safety profile. Nevertheless, most data still come from retrospective series, and many studies included heterogenous patient groups pooling complex surgical leaks with minor endoscopic perforations. This review focuses on the endoscopic management of the more difficult postsurgical leaks. Stents and over-the-scope clips are currently the key endoscopic techniques for leak closure, but emerging techniques such as vacuum sponge therapy and endoscopic internal drainage have proved to be at least as effective. The current trend is to use these different techniques interchangeably or simultaneously rather than assuming a single standardized approach.

    Cited By: 2

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  • Review Article 2016-03-31

    Endoscopic closure of iatrogenic perforation

    Phonthep Angsuwatcharakon, and Rungsun Rerknimitr

    Abstract : Iatrogenic perforation of the gastrointestinal (GI) tract is one of the serious complications in GI endoscopy. With the advancement in technique of GI endoscopy especially therapeutic endoscopy, the risk of perforation has increased. Prompt detection is the only way to avoid delay treatment and poor outcome. Recently, there are new instruments and techniques developed that can be reliably applied for an endoscopic closure without the need for surgery. Therefore, endoscopists should be familiar with these instruments as the result of successful endoscopic closure has lower rate of morbidity than surgery. In this review, the techniques of endoscopic closure are described according to the organs of perforation. In addition, the general knowledge and management of perforation in other aspects including tension pneumothorax, abdominal compartment syndrome, or infection induced by contamination of GI content are explained.

    Cited By: 1

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  • Review Article 2016-03-31

    Segmental arterial mediolysis: Literature review focused on radiologic findings and management

    Seung Yeon Noh, Ji Hoon Shin, Hyun-Ki Yoon, Gi-Young Ko, and Kyu-Bo Sung

    Abstract : Segmental arterial mediolysis (SAM) is a rare disease which can have catastrophic consequences due to massive hemorrhage or dissecting hematomas. The pathophysiology of this disease is not well-known, and the symptoms vary according to the organs involved. In many patients the diagnosis is based on the clinical and radiologic features rather than the pathologic confirmation. The catheter-based endovascular technique can be an interventional treatment option for SAM, as well as surgical management.

    Cited By: 1

  • Review Article 2016-03-31

    Systematic review of 12 years of thermal ablative therapies of non-resectable colorectal cancer liver metastases

    Sameh Saif, Ania Z. Kielar, and Matthew McInnes

    Abstract : To compare the effectiveness and complications of various thermal ablative therapies through reviewing the available literature. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement was used to report this systematic review. Our PICO (patient group-intervention-comparator-outcomes) question: In patients with unresectable colorectal cancer liver metastasis (CRCLM), what are the comparative effectiveness and complication rates of the various thermal ablative therapies? All study designs published between 2000 and 2012 considered. Search results were screened in duplicate to determine eligible studies. A customized “risk of bias” assessment tool was utilized. Asymmetry of the funnel plot and heterogeneity were quantified. Representative forest plots of the 1, 3, and 5 years survival rates, major complication rates and local recurrence rates were performed. Data not amenable to pooling is presented in a qualitative and tabular manner. Thirty radiofrequency ablation (RFA), 11 cryoablation (CA), and 5 microwave ablation (MWA) studies were finally included in the qualitative synthesis. The number of patients included from all the studies was 3,107 patients; 2,021 in the RFA group, 988 in the CA, and 98 in the MWA. The forest plots confirm the significant heterogeneity of the included studies. Visual assessment of forest plots, as well as qualitative analysis of included papers suggested that between-studies heterogeneity was too great and thus, pooling through meta-analysis was not appropriate. RFA is the most commonly used ablative modality to treat unresectable CRCLM. Significant heterogeneity of the included studies was encountered precluding a meaningful meta-analysis. Future comparisons of local ablative therapies outcome necessitate prospective, randomized controlled studies.

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  • Review Article 2016-03-31

    Evaluation of malignant intraductal papillary mucinous neoplasms of the pancreas on computed tomography and magnetic resonance imaging

    Nieun Seo, and Jae Ho Byun

    Abstract : Preoperative cross-sectional imaging, such as computed tomography and magnetic resonance imaging, plays a key role in differentiating between benign and malignant intraductal papillary mucinous neoplasms. This article reviews the imaging features associated with malignant intraductal papillary mucinous neoplasm, as well as the recent studies validating the 2012 international consensus guidelines. This review also compared the diagnostic performance of computed tomography and magnetic resonance imaging in differentiating malignant from benign intraductal papillary mucinous neoplasms.

    Cited By: 1

  • Review Article 2016-03-31

    Interventional radiologic approach to hilar malignant biliary obstruction

    Dong Il Gwon

    Abstract : Biliary obstruction due to advanced hepatic hilar malignancy is difficult to treat, both surgically and non-surgically, using endoscopic or percutaneous drainage. Since only about 10% to 20% of patients are eligible for resection of hepatic hilar malignancies, most patients receive palliative rather than curative treatment. Percutaneous palliation of advanced hepatic hilar malignancies can be accomplished in a variety of ways. Percutaneous bilateral metallic stent placement may be a reasonable option in patients with hilar malignancies to preserve the functional volume of the liver during the course of chemotherapy and to prevent procedure-related cholangitis of a contaminated undrained lobe. Percutaneous bilateral stent-in-stent placement using wide-mesh or open-cell design stents is a feasible and effective method of achieving bilateral drainage. Moreover, unilateral covered or uncovered metallic stent placement in the lobe with patent portal vein is safe and effective method for palliative treatment in patients with contralateral portal vein occlusion caused by hilar malignancies, obviating the need for bilateral stent placement in these patients.

    Cited By: 1

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  • Review Article 2016-03-31

    Multiple metallic stents placement for malignant hilar biliary obstruction: Perspective of a radiologist

    Yozo Sato, Yoshitaka Inaba, Kazuo Hara, Hidekazu Yamaura, Mina Kato, Shinichi Murata, and Yui Onoda

    Abstract : In the palliative setting, the necessity of biliary drainage of both liver lobes for malignant hilar biliary obstruction remains controversial. However, bilateral biliary drainage is a reasonable option to prevent cholangitis of the undrained lobe and to preserve liver function during the course of chemotherapy. Bilateral biliary drainage can be accomplished by the percutaneous or endoscopic placement of multiple self-expandable metallic stents (SEMS). Although SEMS placement via bilateral (multiple) percutaneous routes is technically simple, multiple percutaneous transhepatic biliary drainage (PTBD) may lead to additional morbidity. SEMS placement via a single percutaneous route is a useful method; however, negotiation of a guidewire into the contralateral bile duct is occasionally impossible if the hilar angle between the right hepatic duct and left hepatic duct is acute. Percutaneous dual SEMS placement is generally performed using the stent-in-stent technique (T configuration or Y configuration) or the side-by-side technique. In addition, the crisscross technique has been reported as being a useful method for trisegmental drainage. The side-to-end technique is also useful for multiple SEMS placement. In the future, the combination of percutaneous intervention and endoscopic ultrasonography-guided procedures may be effective in the management of malignant hilar biliary obstruction.

    Cited By: 0

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  • Review Article 2016-03-31

    Articulated percutaneous plastic biliary stents: How to do it

    Jorge E. Lopera

    Abstract : The use of articulated plastic biliary stents is not well known. This technique allows drainage of two or more biliary segments using a single percutaneous access in hilar lesions. In patients that need dilatation of benign biliary stenoses, articulated plastic biliary stent allows placing two or more plastic in the area of stenosis achieving a large internal temporal dilatation while using smaller external biliary drains.

    Cited By: 0

  • Original Article 2016-03-31

    Lidocaine spray on an endoscope immediately before insertion improves patient tolerance to endoscopy: A single center, clinical observational study

    Byung Hyo Cha, Ban Seok Lee, Jin-Hyuck Hwang, Sang Hyub Lee, Min Jung Park, and Seung Joo Kang

    Abstract : BackgroundTopical pharyngeal anesthesia reduces discomfort during upper gastrointestinal endoscopy (UGIE) but may not increase tolerance to the procedure. This case-control study was performed to assess whether lidocaine spray on the endoscope in addition to pharyngeal anesthesia improves patient tolerance to endoscopy we performed.MethodsPatients who underwent UGIE were assigned to either the case group where the endoscope was treated with 2 sprays of 10% lidocaine before insertion or the control group given only conventional pharyngeal anesthesia. And we compared the frequency of belching and retching during endoscopy.ResultsAmong 497 eligible patients, 262 were assigned to the case group and 235 to the control group. There were significant differences between the two groups in belching (odds ratio [OR] = 0.15, 95% confidence interval [CI] = 0.09?0.24, P < 0.01) and retching (OR = 0.22, 95% CI = 0.15?0.34, P = 0.01) during endoscopy using multivariate analysis. Younger patients (OR = 0.96, 95% CI = 0.94?0.98, P < 0.01) and female patients (OR = 2.16, 95% CI = 1.40?3.33, P = 0.01) had belching more frequently than older patients and male patients, respectively. Retching was more frequent in sedated patients (OR = 0.39, 95% CI = 0.25?0.61, P = 0.01) and those with gastro-esophageal reflux disease (OR = 1.48, 95% CI = 1.00?2.21, P = 0.06).ConclusionUse of lidocaine spray on the endoscope improves patient tolerance during UGIE compared to only conventional pharyngeal anesthesia.

    Cited By: 1

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